Genitourinary tuberculosis (GUTB) is a debilitating condition that often necessitates surgical intervention to preserve renal function. Robot-assisted ureterocalycostomy is a complex procedure that offers a minimally invasive solution for salvaging the tuberculous kidney. However, the surgical nuances of this procedure in the context of GUTB remain poorly elucidated.

We present a challenging case of a 28-year-old female with extensive GUTB, necessitating robot-assisted ureterocalycostomy to salvage the affected kidney. The procedure was performed using the da Vinci Xi robotic system, with meticulous attention to preserving the fragile, tuberculous renal tissue. initially, dense adhesions were encountered surrounding the ureter, which were successfully dealt with robotically, without sacrificing ureteral vascularity or length.

The procedure was successfully completed with a console time of 150 minutes and an estimated blood loss of 150 mL. The abdominal drain was removed on post-operative day-2, and the urinary catheter was removed on post-operative day-3. The patient experienced an uneventful postoperative recovery, with preservation of renal function and resolution of symptoms. The patient was discharged on post-operative day-2.

This case underscores the therapeutic efficacy and technical feasibility of robot-assisted ureterocalycostomy in salvaging the tuberculous kidney, notwithstanding the presence of extensive, debilitating disease. The successful outcome of this procedure highlights the paramount importance of meticulous surgical craftsmanship, precision dissection, and judicious preservation of renal tissue, thereby optimizing postoperative renal function and mitigating the risk of long-term sequelae. Ultimately, this case contributes meaningfully to the burgeoning literature on the surgical management of genitourinary tuberculosis, providing valuable insights and nuanced perspectives for urologists and robotic surgeons navigating the complexities of this challenging condition.